By Dr. Margaret Cottle

In the tender compassion of our God the dawn from on high shall break upon us,

To shine on those who dwell in darkness and the shadow of death,

and to guide our feet into the way of peace. 

Luke 1:78-9

In the 1960’s, British physician Cicely Saunders was inspired by her Christian faith to found the modern hospice movement, bringing creativity and rigorous science to end of life care.  In the 1970’s, Dr. Balfour Mount from Montreal introduced hospice medicine to Canada.  The name was changed to palliative care because “hospice” has a negative connotation in French.  The term comes from the Latin pallium, a cloak, since palliative care seeks to cover what cannot be cured.  Acceptance of palliative care grew slowly through the hard work of these visionaries, but the unmet needs continue to be substantial.

During the past 25 years I have been privileged to work in palliative care. Our focus is to care for the whole patient, acknowledging the family as the unit of care.  We work very hard--and do a great job--in relieving pain and other symptoms in hospitals, in hospices and at home, but our treatments go well beyond physical concerns.  Dr. Saunders coined the term “total pain” to refer to the interaction between physical, social, psychological and spiritual factors in how we all experience pain.  Patients with spiritual distress may have physical pain that is hard to control until these issues have been addressed.  A young woman thought her pelvic pain was a “curse from God”.  Once our team and her pastor had reassured her of God’s unconditional love for her, her pain was fully controlled with less medication.  Familial or social issues also have an impact.  A widow was restless and in pain, but her hidden anguish was for her only child, a son with a developmental disability for whom she had been caring for 40 years.  Once she trusted us enough to share this concern, we found an excellent group home for her son and our patient needed half the previous amount of medication to control her pain completely.

One major frustration for Canadian palliative care professionals is highlighted in the findings of the Parliamentary Committee on Palliative and Compassionate Care: less than one in three Canadians has access to adequate palliative care.  Almost three quarters of Canadians are suffering needlessly due to lack of resources.  Another frustration is that a small group within our profession--with a misguided sense of compassion--has been supporting euthanasia and physician assisted suicide.  This is very dangerous and utterly unnecessary.  Do not be deceived.  Patients do not need hastened death; they need excellent care and a deep understanding of their difficult situations.  They need all of us to be present with them in profound solidarity. They need the resources that 70% do not have. 

In fact, in places where these practices are legal there has been rapid expansion and a total lack of enforcement of so-called “safeguards”.  Patients with mental illnesses, early stage eye disease and even ringing the ears have been euthanized.  Children and patients with dementia have also been targets, neither of whom can provide meaningful “consent”.  In one study published in the Canadian Medical Association Journal in June of 2010*, the physicians who reported that they had caused the death of the patients admitted anonymously that one in every three of those patients had never given explicit consent.

Every doctor knows that it is frighteningly easy for patients to die--keeping them alive is the hard work, and caring for them respectfully and compassionately in the process is even tougher.  It takes courage and hope to treat patients, especially when the outcome is far from certain.  Agreeing with patients that their lives are not worth living and helping them to die not only destroys the trust between patients and physicians, it also reveals a distinct lack of imagination.  Real creativity is shown by finding ways to reach people in despair, both at the end of life and in other circumstances, and to make it clear that they matter to us, that their lives are important and that we will be with them in their troubles. 

Our team members will confirm that there is a deep joy that comes able to help patients and families by relieving pain—physical, psychological, social and spiritual, and that journeying with our fellow-travelers in their dark times brings richness to the lives of everyone involved and a new appreciation for the depth of the human spirit.

Look around!  The world is overflowing with evidence of the Lord’s limitless creativity, His delightful imagination, His gracious provision and His lovingkindness--even in difficult circumstances. He is inviting us to join Him as He cares for His children.  What a privilege.  Let’s not miss it!

And God is able to make all grace abound to you, so that in all things at all times, having all that you need, you will abound in every good work.

2 Corinthians 9:8 (NIV)



 This article first appeared in LifeCanada's Reflections Magazine, January 2015.

Dr. Margaret Cottle is a Palliative Care physician in Vancouver, BC.  For over 25 years Dr. Cottle’s practice has been exclusively dedicated to the care of dying patients and their loved ones.  She is a clinical instructor at the UBC medical school where she teaches clinical skills and palliative care. 




*CMAJ. 2010 Jun 15;182(9):895-901. Epub 2010 May 17. Physician assisted deaths under the euthanasia law in Belgium: a population based survey.

photo credit: Anne Worner Staying Informed via photopin (license)